Please complete the following informations.

Do you play profesional sport or are you in the entertainment industry?

Have you ever been convicted of a felony?

Did you purchase loose stones?

GemShield/IJN is a jewelry insurance
replacement program, underwritten by Berkley Asset Protection. If you incur a loss,
your jewelry will be replaced with a piece of like kind and quality from the participating
jeweler who originally sold you the item. It is a worldwide insurance policy that
includes coverage for sudden and accidental damage and mysterious disappearance.
You will receive your insurance premium receipt by email
and the policy will follow.
Your Jeweler is not a licensed agent of Gemshield and does not sell insurance.

Disclosure Agreement

I understand and acknowledge that incorrect information may make my policy unenforceable and that it can be a criminal or civil crime to knowingly and with intent to mislead, file an insurance application containing any false information or conceal information concerning any material fact. I also understand and acknowledge that for the failure or refusal of any insurance carrier to cover or pay any loss or claim, that I release and discharge Wasserman & Wexler LLC, Sonic Insurance Agency, Hallberg Insurance Network, from any liability due from such failure or refusal.

Personal information about you, including information from a credit or other investigative report, may be collected from persons other than you in connection with this application for insurance and subsequent amendments and renewals. Such information as well as other personal and privileged information collected by us or our agents may in certain circumstances be disclosed to third parties without your authorization. Credit scoring information may be used to determine either your eligibility for insurance or the premium you will be charged. We may use a third party in connection with the request for correction of any inaccuracies. A more detailed description of your rights and our practices regarding such information is available upon request. Contact your agent or broker for instruction on how to submit a request to us.

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Processing and Data Transmission Convenience Fee

The Technology Processing Company is pleased to provide you with the technology that immediately transmits your information, including the jewelry data, to the insurance company. This is a unique convenience solution that enables your new jewelry purchase to be fully insured during your online purchase. The Technology Processing Company charges a one-time applicable fee for processing this service and is not charged on renewals. I have full knowledge and consent to being charged the above applicable processing fees for data transmission and storage by the Technology Processing Company.

By checking the checkbox, I certify that I have read and agree with the above statement and agree to accept the convenience processing fees charged by the Technology Processing Company on my credit card.